Responsible for countless health problems, including cardiovascular and respiratory illness, and many forms of cancer, smoking commonly leads to hospitalization. Surprisingly, a minority of Canadian hospitals have systems, policies or procedures in place that support the consistent, effective identification and treatment of tobacco users admitted to their institutions.
The Ottawa Heart Institute, which has been championing comprehensive tobacco cessation treatments during hospitalization for well over a decade, was recently awarded $3.5 million to implement a new and innovative intervention for hospitalized smokers in collaboration with Lakehead University’s Moving On to Being Free program. Funded by the Ontario Ministry of Health and Long-Term Care, the pilot project aims to reduce barriers to the use of cessation pharmacotherapies by smokers by delivering more than 15,000 “Quit Cards” to high-risk smokers through Ontario hospitals and specialty care clinics to help them purchase nicotine replacement therapies. The project will also enhance smoking cessation program delivery to priority populations through improved program coordination.
“Many smokers identify the cost of smoking cessation medications as a main barrier to quitting,” said Kerri-Anne Mullen, Program Manager for the Heart Institute’s Ottawa Model for Smoking Cessation Network. “Easy access to cost-free smoking cessation medication on discharge has rarely been made available to participants of hospital-initiated interventions in Ontario.”
This initiative will evaluate the effectiveness of smoking cessation payment cards (Quit Cards) that smokers can use to purchase single or combination nicotine replacement therapies (patch, gum, inhaler, lozenge or mist). The Quit Cards will be distributed to nearly 80 healthcare sites that are part of the OMSC or Lakehead University provider networks.
“The OMSC team, headquartered at the Ottawa Heart Institute, works with hospitals, primary care and other healthcare clinics to implement a protocol and tools for incorporating smoking cessation treatment as part of routine care,” explained Mullen. “We train thousands of health professionals every year on how to deliver tobacco treatment interventions to smokers.”
Expert OMSC Outreach Facilitators work with individual healthcare sites to adapt their clinical practices to systematically treat tobacco dependence. Once a smoking cessation program is launched, feedback and quality improvement processes allow the program to be refined and sustained.
“Developing a simple yet comprehensive system leads to the consistent identification, documentation, treatment and follow-up of all patients or clients who smoke. This results in more attempts to quit and, ultimately, more smokers becoming smoke-free,” said Mullen. “What is so promising about the Quit Card initiative is that it will, for the first time since the OMSC has expanded to other hospitals beyond the Heart Institute, provide continued coverage for nicotine replacement therapies available to hospitalized patients after they leave the hospital.”
Patients who receive a Quit Card from a health professional during an initial smoking cessation consultation will be enrolled in follow-up support and will be able to take their Quit Card to any Ontario pharmacy to purchase nicotine replacement therapy products. The Quit Card will be processed by pharmacies in the same way medication insurance cards are processed. Only products specified on the Quit Card by Drug Information Number (DIN) will be eligible for purchase. The card will have an initial value of $150 and patients will be able to load an additional $300 on the card based on their need.
Patient follow-up support will include enrolment in automated telephone or email follow-up where they respond to questions related to their quit attempt. The system is monitored by smoking cessation counsellors who contact patients in need of additional support.
“Becoming smoke-free can add years to a smoker’s life and can prevent the onset or progression of serious chronic health conditions,” said Mullen. “That’s why smoking cessation is the most important intervention we can offer to any patient who smokes.”
The Quit Card tracking system will track where the cards were distributed (healthcare site and jurisdiction), the number of cards distributed, the number of cards redeemed and the type of nicotine replacement used.
“Our work has always been based on principles of knowledge translation. We will be sharing the insights gathered from this project with all participating sites, as well as the Smoke-Free Ontario Strategy and the Ontario Ministry of Health and Long-Term Care,” Mullen said. “Ideally we will be able to continue offering this initiative to high-risk smokers seen in hospitals and healthcare clinics so that more smokers in Ontario can benefit.”